Mycobacterium tuberculosis is the commonest pathogen leading to fatal opportunistic disease in sub-Saharan Africa. South Africa is one of 5 countries with HIV-positive TB > 300 cases/100,000This proposal aims at demonstrating the benefits of antiretroviral therapy on TB in the community of Masiphumelele. Because the major cause of morbidity and mortality in HIV-1 infected adults and children is TB, safeguarding the household from the disease is a public health priority Project hypothesis: The introduction of ART in HIV-positive members of a community will have an impact on the TB morbidity and mortality in both HIV negative and positive members. Masiphumelele, a well circumscribed community of 10,000 in Cape Town where 600 adults, 100 children and 60 neonates will be treated with ART (Project 1 and 2 of this CIPRA). In addition it is our hypothesis that ART will change transmission patterns of tuberculosis in this community. Specific Aims: 1. To measure the impact of community-based antiretroviral therapy (ART) on active tuberculosis case rates, TB hospitalization rates and tuberculosis death rates, of the community residents, both HIV infected and un-infected. 2. To measure the impact of ART on the proportion of active TB in HIV infected individuals due to reactivation of latent infection versus reinfection. 3. To measure the impact of ART on transmission patterns of TB within the community. Is there a reduction of cluster sizes of M. tuberculosis? 4. To measure the contribution of HIV infected individuals to the transmission of TB. 5. To type the strains of M. tuberculosis cultured from the community using restriction length polymorphism (RFLP) to determine if the introduction of ART will change the transmission patterns of tuberculosis qualitatively as well as quantitatively in this community. 6. To use a geographic information system (GIS) and RFLP database for the Masiphumelele village, identifying TB transmission locations. 7. To measure the ongoing transmission of TB using annual tuberculin skin tests (TST) in cohorts of local school children and correlate it with the successful use of ART by. the reduction in AIDS related deaths, opportunistic infections and hospitalizations.